October 6, 2012A fascinating, if disconcerting, fact: More than 100 trillion so-called good bacteria thrive in or on the human body. A sizable chunk of them maintain residence in the human digestive tract. Probiotics, live microorganisms that benefit their human host, are among these beneficial bacteria.

Probiotics are also found in foods and supplements, and when consumed they change how the immune system responds to "bad" bacteria.

"Probiotics seem to enhance the intestinal flora and promote a healthier gut environment," says Jeannie Gazzaniga-Moloo, a registered dietitian in Sacramento and a spokeswoman for the Academy of Nutrition and Dietetics. Scientists don't know exactly how probiotics work, but they may also produce anti-microbial substances that destroy harmful microorganisms and stimulate an immune response.

Even though probiotics-infused foods may seem like a modern phenomenon, the idea that consuming living microorganisms could improve health was introduced more than 100 years ago. That's when Elie Metchnikoff, a Nobel-winning scientist, proposed the idea in his book, "The Prolongation of Life: Optimistic Studies."

"Certain dairy products, especially yogurt, contain probiotics naturally," Gazzaniga-Moloo adds, but more recently probiotics have been added to juice, cereal, cookies and more. There are also dozens of probiotic supplements — capsules, tablets and powders — on the market.

Why are food manufacturers adding bacteria to foods that don't contain them? Some studies suggest that probiotics may help prevent and treat vaginal yeast infections and urinary tract infections, may prevent eczema in children and may reduce the severity and longevity of colds and flu. Other studies have shown definitively that people who are suffering from antibiotic-associated diarrhea benefit from consuming probiotics. Most recently, an analysis that appeared in the May issue of the Journal of the American Medical Assn. found that people who are suffering from diarrhea because they are taking antibiotic medications may reduce the risk of diarrhea by 42% if they consume probiotics. While some advocates claim that probiotics reduce the symptoms of irritable bowel syndrome and Crohn's disease, the evidence doesn't yet bear this out. Nor has the U.S. Food and Drug Administration approved any health claims for probiotics.

"I have clients who swear that once they start eating more foods with probiotics they have less bloating and gastrointestinal discomfort, fewer colds and flu," says Gazzaniga-Maloo.

As we start to stare down cold and flu season, a 2009 study that was published in Pediatrics is worth revisiting. The study, which was funded by a company that makes products with probiotics, compared two groups of kids, 326 total, ages 3 to 5, who drank milk with either Lactobacillus acidophilus or Bifidobacterium animalis or plain milk twice a day. The kids who consumed the probiotics-infused milk ultimately got half as many fevers and fewer runny noses than the kids who drank plain milk. Their symptoms also didn't last as long, they took fewer prescriptions and missed fewer days of school than the kids who drank the plain milk.

An Outcast Among Peers Gains Traction on Alzheimer's Cure By JEANNE WHALEN

Gareth Phillips for The Wall Street Journal

After years of effort, researcher Dr. Claude Wischik is awaiting the results of new clinical trials that will test his theory on the cause of Alzheimer's..Some people collect stamps, others vintage cars. As a young Ph.D. student at Cambridge University in the 1980s, Claude Wischik was on a mission to collect brains.

It wasn't easy. At the time, few organ banks kept entire brains. But Dr. Wischik, an Australian in his early 30s at the time, was attempting to answer a riddle still puzzling the scientific community: What causes Alzheimer's disease? To do that, Dr. Wischik needed to examine brain tissue from Alzheimer's patients soon after death. That meant getting family approvals and enlisting mortuary technicians to extract the brains, he says, "no matter the time of day or night." And it wasn't just a few brains: he collected more than 300 over about a dozen years.

He also embraced an idea that, if he is right, could ultimately spin Alzheimer's research on its heels—and raise new hopes for the roughly 36 million people world-wide afflicted with Alzheimer's or dementia.

Alzheimer's researcher Claude Wischik has long backed a minority view: that a protein in the brain called tau-not plaque-is largely responsible. WSJ's Shirley Wang spoke with Dr. Wischik about his work on a new drug to treat the devastating disease..The 63-year-old researcher believes that a protein called tau—which forms twisted fibers known as tangles inside the brain cells of Alzheimer's patients—is largely responsible for driving the disease. It is a theory that goes against much of the scientific community: For 20 years, billions of dollars of pharmaceutical investment has supported a different theory that places chief blame on a different protein, beta amyloid, which forms sticky plaques in the brains of sufferers. But a string of experimental drugs designed to attack beta amyloid have failed recently in clinical trials, including two this summer from Eli Lilly LLY 0.00%& Co. and a partnership involving Pfizer Inc., PFE +0.04%Johnson & Johnson JNJ +0.32%and Elan Corp. DRX.DB +2.30%After years on the sidelines, Dr. Wischik, who now lives in Scotland, sees this as tau's big moment. The company he co-founded 10 years ago, TauRx Pharmaceuticals Ltd., has developed an experimental Alzheimer's drug that it will begin testing in the coming weeks in two large clinical trials. Slowly, other companies are boosting investment in tau research, too. This summer, Roche Holding AG ROG.VX -0.11%bought the rights to a type of experimental tau drug from Switzerland's closely held AC Immune SA.

History is peppered with examples of scientists who struggled against a prevailing orthodoxy, only to be proved right. In 1854, British doctor John Snow traced a cholera outbreak in London to a contaminated water supply, but his discovery was rejected by other scientists, who believed bad vapors in the air caused the disease. In the 1880s, cholera was finally pegged to bacteria found in contaminated water. In 1982, when two Australian scientists declared that bacteria caused peptic ulcers, conventional wisdom had it that stress and lifestyle were to blame. The scientists won the 2005 Nobel Prize in medicine for their discovery.

It is far from clear whether Dr. Wischik will join their ranks. Although interest in tau is building, opinions about the cause of Alzheimer's remain deeply divided. Some scientists believe an interaction between beta amyloid and tau plays a central role. Others think there are many possible triggers, including some beyond beta amyloid or tau.

Dr. Wischik says he and other tau-focused scientists have been shouted down over the years by what he calls the "amyloid orthodoxy," a hard-charging group of researchers who believed passionately that beta amyloid was the chief cause of the disease. "Science is politics," he says. "And the politics of amyloid won."

Yet Dr. Wischik has also been hampered by inconclusive research. A small clinical trial of TauRx's drug in 2008 produced encouraging, but mixed, results. What's more, plenty of influential scientists still are backing the idea that beta amyloid plays a central role. Although Roche is investing in tau, Richard Scheller, head of drug research at Roche's biotech unit, Genentech, says the company still is a strong believer in beta amyloid. He thinks amyloid drugs need to be tested on Alzheimer's patients much earlier in the disease cycle in order to prove effective; Roche recently announced plans to conduct such a trial.

Meanwhile, scientists Dr. Wischik accuses of wrongly fixating on beta amyloid, such as Harvard neurologist Dennis Selkoe, say the evidence for pursuing amyloid is strong. "Claude I think sees the world somewhat darkly…if we've made our case more potently for [beta amyloid], there is nothing wrong with that," Dr. Selkoe says. He adds that he supports tau research, as well, and believes drugs to attack both beta amyloid and tau will be necessary.

Alzheimer's disease is the leading cause of dementia in the elderly, and according to the World Health Organization, the cost of caring for dementia sufferers totals about $600 billion each year world-wide. The disease was first identified in 1906 by German physician Alois Alzheimer, who studied the brain of a deceased woman who had suffered from dementia and documented the plaques and tangles that riddled the tissue. The following decades brought few advancements in understanding the disease, in part because of the difficulty of studying the human brain, which unlike other tissues cannot be biopsied and examined until after death.

Still, in the 1960s, British scientist Martin Roth and colleagues showed that the degree of clinical dementia was worse for patients with more tangles in the brain. In the 1980s, Dr. Wischik joined Dr. Roth's research group at Cambridge University as a Ph.D student, and was quickly assigned the task of determining what tangles were made of, which launched his brain-collecting mission, and years of examining tissue.

Finally, in 1988, he and colleagues at Cambridge published a paper demonstrating for the first time that the tangles first observed by Alzheimer were made at least in part of the protein tau. Later research identified tau as the main ingredient. Like all of the body's proteins, tau has a normal, helpful function—working inside neurons to help stabilize the fibers that connect nerve cells. But when it misfires, tau can clump together to form harmful tangles that kill brain cells.

Dr. Wischik's discovery was important news in the Alzheimer's field: identifying the makeup of tangles made it possible to start developing ways to stop their formation. But by the early 1990s, tau was overtaken by another protein: beta amyloid.

Signs of DeclineView Interactive..Several pieces of evidence convinced an influential group of scientists that beta amyloid was the primary cause of Alzheimer's. Among these was the discovery of several genetic mutations that all but guaranteed a person would develop a hereditary type of the disease. These mutations also appeared to increase the production or accumulation of beta amyloid in the brain, leading scientists to believe that amyloid deposits were the main cause of the disease.

The so-called "amyloid hypothesis" quickly gripped the field, and attacking the protein became the main strategy for fighting Alzheimer's. Athena Neurosciences, a biotech company whose founders included Harvard's Dr. Selkoe, focused in earnest on developing drugs to attack amyloid. Meanwhile, tau researchers say they found it hard to get research funding or to publish papers in medical journals.

"It was very difficult to have a good publication on tau, because the amyloid cascade was like a dogma," says Luc Buee, a tau-focused researcher at the French National Institute of Health and Medical Research. "For 15 years if you were not working in the amyloid field you were not working on Alzheimer's disease."

Dr. Wischik and his colleagues fought to keep funding from the UK's Medical Research Council for the repository of brain tissue they maintained at Cambridge, he says. The brain bank became an important tool. In the early 1990s, Dr. Wischik and his colleagues compared the postmortem brains of Alzheimer's sufferers against those of people who had died without dementia, to see how their levels of amyloid and tau differed. They found that both healthy brains and Alzheimer's brains could be filled with amyloid plaque, but only Alzheimer's brains contained aggregated tau. What's more, as the levels of aggregated tau in a brain increased, so did the severity of dementia. "We decided that amyloid isn't what is making people demented," Dr. Wischik says.

In the mid-1990s, Dr. Wischik discovered that a drug sometimes used to treat psychosis dissolved tangles in a test tube. He tried to set up a company to develop the drug as a treatment for Alzheimer's, but found that American and British venture capitalists wanted to invest in amyloid projects, not tau.

By 2002, Dr. Wischik scraped together about $5 million from Asian investors with the help of a Singaporean physician who was the father of a classmate of Dr. Wischik's son in Cambridge. TauRx is based in Singapore but conducts most of its research in Aberdeen, Scotland.

As his tau effort launched, early tests of drugs designed to attack amyloid plaques were disappointing. A vaccine developed by Athena Neurosciences failed to improve patients' cognitive function in a trial that ended in 2002.

To better understand these results, a team of British scientists largely unaffiliated with Athena or the failed clinical trial decided to examine the brains of patients who had participated in the study. They waited for the patients to die, and then, after probing the brains, concluded that the vaccine had indeed cleared amyloid plaque but hadn't prevented further neurodegeneration.

Commitment to the amyloid hypothesis persisted, however. Peter Davies, an Alzheimer's researcher at the Feinstein Institute for Medical Research in Manhasset, NY, recalls hearing a researcher at a conference in the early 2000s concede that his amyloid research results "don't fit the hypothesis, but we'll keep going till they do."

"I just sat there with my mouth open," he recalls.

In 2004, TauRx began a clinical trial of its drug, called methylene blue, in 332 Alzheimer's patients. Around the same time, a drug maker called Elan Corp., which had bought Athena Neurosciences, began a trial of an amyloid-targeted drug called bapineuzumab in 234 patients.

A key moment came in 2008, when Dr. Wischik and Elan presented results of their studies at an Alzheimer's conference in Chicago. The Elan drug failed to improve cognition any better than a placebo pill, causing Elan shares to plummet by more than 60% over the next few days.

The TauRx results Dr. Wischik presented were more positive, though not unequivocal. The study showed that, after 50 weeks of treatment, Alzheimer's patients taking a placebo had fallen 7.8 points on a test of cognitive function, while people taking 60 mg of TauRx's drug three times a day had fallen one point—translating into an 87% reduction in the rate of decline for people taking the TauRx drug.

But TauRx didn't publish a full set of data from the trial, causing some skepticism among researchers. (Dr. Wischik says it didn't to protect the company's commercial interests). What's more, a higher, 100-mg dose of the drug didn't produce the same positive effects in patients; Dr. Wischik blames this on the way the 100-mg dose was formulated, and says the company is testing a tweaked version of the drug in its new clinical trials, which will begin enrolling patients late this year.

Meanwhile, drugs designed to attack beta amyloid have continued to disappoint. This summer, a trio of companies that now own the rights to bapineuzumab—Elan, Pfizer and Johnson & Johnson—scrapped development of the drug after it failed to work in two large clinical trials.

Then in August, Eli Lilly & Co. said its experimental medicine targeting beta amyloid, solanezumab, failed to slow the loss of memory or basic skills like bathing and dressing in two trials involving 2,050 patients with mild or moderate Alzheimer's. Just recently, Lilly disclosed that in one of the trials, when moderate patients were stripped away, the drug slowed cognitive decline only in patients with mild forms of the disease. Lilly said it would talk to regulators before deciding what to do next with the experimental drug.

The trial failures have tempered support for the amyloid hypothesis, but there are still fervent believers who say beta amyloid needs to be attacked very early in the disease cycle—perhaps before symptoms begin—for such medicines to work. This spring, the U.S. government said it would help fund a $100 million trial of Roche's amyloid-targeted drug, crenezumab, in 300 people who are genetically predisposed to develop early-onset Alzheimer's but who don't yet have symptoms. Dr. Selkoe, one of the authors of the amyloid hypothesis, says this trial should help provide a "definitive" answer about the theory.

Scientists and investors, meanwhile, are turning more attention to tau. Roche this year said it would pay Switzerland's AC Immune an undisclosed upfront fee for the rights to a new type of tau-targeted drug, and up to CHF400 million in additional payments if any drugs make it to market.

Dr. Buee, the longtime tau researcher in France, says Johnson & Johnson asked him to provide advice on tau last year, and that he's currently discussing a tau research contract with a big pharmaceutical company. (A Johnson & Johnson spokeswoman says the company invited Dr. Buee and other scientists to a meeting to discuss a range of approaches to fighting Alzheimer's.)

With its new clinical trial program under way, TauRx is the first company to test a tau-targeted drug against Alzheimer's in a large human study, known in the industry as a phase 3 trial. With his passionate beliefs, Dr. Wischik admits he may be just as much a zealot about tau as he accuses others of being about beta amyloid. "I may be," he says. "In the end…it's down to the phase 3 trial."

Where Salt Is Lurking on Restaurant Menus Navigating Around Sodium When Dining Out Takes Inside Information • By ALINA DIZIK American adults eat in restaurants an average of five times a week—which means they probably eat way too much salt. Even fine-dining menus offer little escape from sodium overload.Starting with the bread and salad and ending with the final plate of tiny cookies, many of restaurants' least salty-seeming options are significant sources of dietary salt.

Some of the tastiest dishes served in restaurants are loaded with salt, often taking health conscious diners by surprise. WSJ contributor Alina Dizik and nutritionist Kristy Lambrou join Lunch Break for a look at which foods are likely to serve up too much salt, and what do do about it. Photo: Ramsay de Give for The Wall Street Journal.The desire to limit salt isn't just for heart-attack patients. Some 90% of Americans will have to contend with high blood pressure in their lifetimes, so it is important for almost everyone to limit their sodium intake, says Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health. Yet restaurant diners who read menus closely tend to be looking to avoid fats, not sodium. "The consequence of too many calories is more conspicuous," Dr. Willett says. "The sodium issue is quite invisible until they have a stroke." Salt is indispensable in restaurant kitchens beyond just how it makes food taste. It extends the shelf life of prepared foods, prevents bitterness in produce and encourages binding in breads, says Joy Dubost, director of nutrition at the National Restaurant Association, a Washington, D.C., industry group. Replacing salt with alternative preparations or seasonings, such as herbs, will almost always end up costing more. Enlarge ImageCloseRamsay de Give for The Wall Street Journal Jeremy Bearman, executive chef, with Kristy Lambrou, nutritionist, at Rouge Tomate.Restaurants often salt raw steaks and chops before browning. And green salads can contain salt, whether added to the leafy greens or present in the dressing, cheese or meat add-ins. Chefs put a little extra vinegar in the dressing to balance out a salty-tasting salad."Something may have lots of salt in it but not taste salty," says Amy Chaplin, a New York recipe developer and personal chef preparing vegetarian cuisine. Even simple cooked vegetables can sneak salt onto the menu, says Kristy Lambrou, a culinary nutritionist who works in the kitchen at Rouge Tomate, a New York restaurant whose menu focuses on healthful eating. To help vegetables retain flavor, nutrients and color, restaurants blanch them, plunging them briefly into boiling salted water and then an ice-water bath. The salt absorbed will vary. Cutting Down on SaltView InteractiveRamsay de Give for The Wall Street Journal (4) Bread, luncheon meats, pizza, poultry, soups, burgers, cheese and pasta dishes are some of the most common sources of dietary sodium, according to the Centers for Disease Control and Prevention. Charcuterie and cheese plates are out of the question for diners limiting salt.Diners also should avoid braised meats and sausages, which also often contain a lot of salt. Skip potatoes when possible, because they are usually prepared with a liberal dose of salt. Ditto soups, gravies, curries and other soupy or saucy dishes, which tend to require more seasoning because the liquid dilutes flavor.Restaurants "use so much more salt than people realize," says Michael Stebner, brand executive chef at True Food Kitchen, a Scottsdale, Ariz., chain developed by Fox Restaurant Group and Andrew Weil, the author of books on integrative medicine. The chain uses recipes modified to require 25% less added salt. Many health experts recommend cutting salt by 25% because they contend it won't drastically change the flavor. Chefs, though, say generous salting more than once in the cooking process helps bring out depth of flavor. Enlarge ImageCloseRamsay de Give for The Wall Street Journal Fresh Herb Tagliatelle More Taste, Less SodiumChef Jeremy Bearman's Fresh Herb Tagliatelle with Maine Lobster has 690 milligrams of sodium—far less than the 1,600 milligrams or more found in a typical serving of traditional pasta and shrimp in tomato sauce.• About 60% of the sodium comes from the lobster itself. Colorful vegetables—leek, fennel, broccoli—provide sensory appeal and potassium to balance the lobster's saltiness. • Housemade pasta is flavored with saffron but not salt, rolled with fresh herbs and cooked in unsalted water. • Minimally salted pasta sauce begins with unsalted fennel stock. It contains leek purée made with saffron, lobster oil, lemon juice, Espellete pepper powder and a pinch of salt. • Lobster oil is made by roasting lobster shells with tomato, white wine, chili flake, peppercorns, tarragon, carrot, celery and onion and then steeping them in olive oil. • A squeeze of fresh lemon adds bright flavor. Source: Rouge Tomate"It opens up the pores on your tongue and enables you to taste the food better," says Mr. Stebner, former owner of the San Diego restaurant Region. Some chefs rely on salt to enhance previously frozen meats or less-than-ripe vegetables, he adds. "Salt is being used to extract more flavor than the food actually has." Sodium is a major cause of high blood pressure, which can lead to both heart attack and stroke, says Rachel Johnson, spokesperson for the American Heart Association and nutrition professor at the University of Vermont. Hypertension affects one in three Americans. The average American consumes more than 3,400 milligrams of sodium per day, more than double the American Heart Association's recommended 1,500 mg, which is the equivalent of two-thirds of a teaspoon of table salt.Restaurant foods are denser in sodium than home-prepared food, the CDC says, and contribute about 25% of sodium in the American diet. Jeremy Bearman, chef at Rouge Tomate, balances sodium-rich ingredients with potassium-rich ingredients, Ms. Lambrou says. Mussels, which like other seafoods are naturally high in sodium, are often paired with tomatoes. "One major [heart disease] contributor is not just having a lot of sodium, but also not having enough potassium," Ms. Lambrou says. "Those are two electrolytes that need to be in balance." The restaurant uses coarse salt, because "pinch for pinch" it has less sodium, she adds.Potassium helps counteract sodium's effects on blood pressure, Dr. Willett says. Most U.S. adults get only about 3,000 mg of potassium a day, far short of the recommended 4,700 mg a day. Dr. Willett says frequent restaurant diners should try to eat more fresh fruits and vegetables, which naturally contain potassium.Most menus don't offer much transparency when it comes to salt. Opt for simple vegetable and fish preparations with olive oil and lemon, grilled proteins and in-season vegetables, says Ms. Chaplin. Spicy preparations can be a good lower-sodium alternatives. And drinking wine with the meal will naturally heighten your desire for more savory, salty flavors, Ms. Chaplin adds.Janet Riccio, 55, a New York advertising executive, says tries to monitor her salt intake because of a genetic disposition to high blood pressure. At business meals, she'll ask the waiter about sodium content before ordering and will usually request sauce on the side. Beyond that, though, there is only so much vetting she feels comfortable doing, out of consideration for the server and her fellow diners. "I hope I'm doing it in a way that doesn't offend anybody," she says.Some restaurateurs are wary when diners request low-sodium preparations, because they don't want to send unappetizing food to the dining room. At Maverick, in San Francisco, Emmanuel Eng, the executive chef, says omitting salt from the chicken liver mousse or the lobster bisque would leave diners unsatisfied. "A dish without salt is not as good as it could be," he says. "We're in the business of pleasing guests."Diners who call ahead are more likely to find a restaurant willing to accommodate a low-sodium request. Ideally, call a day or two ahead so the chef can set aside unsalted portions. Start with restaurants whose menus emphasize fresh ingredients. "When [they] use fresh products, the restaurants can focus on adding lots of herbs and spices or doing reductions and layering flavors" instead of simply adding salt, says Darcie Ellyne, a Burlingame, Calif., nutrition consultant to chains including Una Mas Mexican Grill and Ruby's Diner.If arriving unannounced, ask the server for recommendations. Try to be flexible. When ordering, ask for "no salt where possible," Mr. Eng says. When diners pop in with surprise special dietary requests, "that can severely limit what we can do on the fly," he adds.

It's Time to End the War on Salt The zealous drive by politicians to limit our salt intake has little basis in science

By Melinda Wenner Moyer

For decades, policy makers have tried and failed to get Americans to eat less salt. In April 2010 the Institute of Medicine urged the U.S. Food and Drug Administration to regulate the amount of salt that food manufacturers put into products; New York City Mayor Michael Bloomberg has already convinced 16 companies to do so voluntarily. But if the U.S. does conquer salt, what will we gain? Bland french fries, for sure. But a healthy nation? Not necessarily.

This week a meta-analysis of seven studies involving a total of 6,250 subjects in the American Journal of Hypertension found no strong evidence that cutting salt intake reduces the risk for heart attacks, strokes or death in people with normal or high blood pressure. In May European researchers publishing in the Journal of the American Medical Association reported that the less sodium that study subjects excreted in their urine—an excellent measure of prior consumption—the greater their risk was of dying from heart disease. These findings call into question the common wisdom that excess salt is bad for you, but the evidence linking salt to heart disease has always been tenuous.

STOCKHOLM (Reuters) - Emelie Olsson is plagued by hallucinations and nightmares. When she wakes up, she's often paralyzed, unable to breathe properly or call for help. During the day she can barely stay awake, and often misses school or having fun with friends. She is only 14, but at times she has wondered if her life is worth living.

Emelie is one of around 800 children in Sweden and elsewhere in Europe who developed narcolepsy, an incurable sleep disorder, after being immunized with the Pandemrix H1N1 swine flu vaccine made by British drugmaker GlaxoSmithKline in 2009.

Finland, Norway, Ireland and France have seen spikes in narcolepsy cases, too, and people familiar with the results of a soon-to-be-published study in Britain have told Reuters it will show a similar pattern in children there.

Their fate, coping with an illness that all but destroys normal life, is developing into what the health official who coordinated Sweden's vaccination campaign calls a "medical tragedy" that will demand rising scientific and medical attention.

Europe's drugs regulator has ruled Pandemrix should no longer be used in people aged under 20. The chief medical officer at GSK's vaccines division, Norman Begg, says his firm views the issue extremely seriously and is "absolutely committed to getting to the bottom of this", but adds there is not yet enough data or evidence to suggest a causal link.

Others - including Emmanuel Mignot, one of the world's leading experts on narcolepsy, who is being funded by GSK to investigate further - agree more research is needed but say the evidence is already clearly pointing in one direction.

"There's no doubt in my mind whatsoever that Pandemrix increased the occurrence of narcolepsy onset in children in some countries - and probably in most countries," says Mignot, a specialist in the sleep disorder at Stanford University in the United States.

30 MILLION RECEIVED PANDEMRIX

In total, the GSK shot was given to more than 30 million people in 47 countries during the 2009-2010 H1N1 swine flu pandemic. Because it contains an adjuvant, or booster, it was not used in the United States because drug regulators there are wary of adjuvanted vaccines.

GSK says 795 people across Europe have reported developing narcolepsy since the vaccine's use began in 2009.

Questions about how the narcolepsy cases are linked to Pandemrix, what the triggers and biological mechanisms might have been, and whether there might be a genetic susceptibility are currently the subject of deep scientific investigation.

But experts on all sides are wary. Rare adverse reactions can swiftly develop into "vaccine scares" that spiral out of proportion and cast what one of Europe's top flu experts calls a "long shadow" over public confidence in vaccines that control potential killers like measles and polio.

"No-one wants to be the next Wakefield," said Mignot, referring to the now discredited British doctor Andrew Wakefield who sparked a decades-long backlash against the measles, mumps and rubella (MMR) shot with false claims of links to autism.

With the narcolepsy studies, there is no suggestion that the findings are the work of one rogue doctor.

Independent teams of scientists have published peer-reviewed studies from Sweden, Finland and Ireland showing the risk of developing narcolepsy after the 2009-2010 immunization campaign was between seven and 13 times higher for children who had Pandemrix than for their unvaccinated peers."We really do want to get to the bottom of this. It's not in anyone's interests if there is a safety issue that needs to be addressed," said GSK's Begg.

LIFE CHANGED

Emelie's parents, Charles and Marie Olsson, say she was a top student who loved playing the piano, taking tennis lessons, creating art and having fun with friends. But her life started to change in early 2010, a few months after she had Pandemrix. In the spring of 2010, they noticed she was often tired, needing to sleep when she came home from school.

But it wasn't until May, when she began collapsing at school, that it became clear something serious was happening.

As well as the life-limiting bouts of daytime sleepiness, narcolepsy brings nightmares, hallucinations, sleep paralysis and episodes of cataplexy - when strong emotions trigger a sudden and dramatic loss of muscle strength.

In Emelie's case, having fun is the emotional trigger. "I can't laugh or joke about with my friends any more, because when I do I get cataplexies and collapse," she said in an interview at her home in the Swedish capital.

Narcolepsy is estimated to affect between 200 and 500 people per million and is a lifelong condition. It has no known cure and scientists don't really know what causes it. But they do know patients have a deficit of a brain neurotransmitter called orexin, also known as hypocretin, which regulates wakefulness.

Research has found that some people are born with a variant in a gene known as HLA that means they have low hypocretin, making them more susceptible to narcolepsy. Around 25 percent of Europeans are thought to have this genetic vulnerability.

When results of Emelie's hypocretin test came back in November last year, it showed she had 15 percent of the normal amount, typical of heavy narcolepsy with cataplexy.

The seriousness of her strange new illness has forced her to contemplate life far more than many other young teens: "In the beginning I didn't really want to live any more, but now I have learned to handle things better," she said.

TRIGGERS?

Scientists investigating these cases are looking in detail at Pandemrix's adjuvant, called AS03, for clues.

Some suggest AS03, or maybe its boosting effect, or even the H1N1 flu itself, may have triggered the onset of narcolepsy in those who have the susceptible HLA gene variant.Angus Nicoll, a flu expert at the European Centre for Disease Prevention and Control (ECDC), says genes may well play a part, but don't tell the whole story.

"Yes, there's a genetic predisposition to this condition, but that alone cannot explain these cases," he said. "There was also something to do with receiving this specific vaccination. Whether it was the vaccine plus the genetic disposition alone or a third factor as well - like another infection - we simply do not know yet."

GSK is funding a study in Canada, where its adjuvanted vaccine Arepanrix, similar to Pandemrix, was used during the 2009-2010 pandemic. The study won't be completed until 2014, and some experts fear it may not shed much light since the vaccines were similar but not precisely the same.

It all leaves this investigation with far more questions than answers, and a lot more research ahead.

WAS IT WORTH IT?

In his glass-topped office building overlooking the Maria Magdalena church in Stockholm, Goran Stiernstedt, a doctor turned public health official, has spent many difficult hours going over what happened in his country during the swine flu pandemic, wondering if things should have been different.

"The big question is was it worth it? And retrospectively I have to say it was not," he told Reuters in an interview.

Being a wealthy country, Sweden was at the front of the queue for pandemic vaccines. It got Pandemrix from GSK almost as soon as it was available, and a nationwide campaign got uptake of the vaccine to 59 percent, meaning around 5 million people got the shot.

Stiernstedt, director for health and social care at the Swedish Association of Local Authorities and Regions, helped coordinate the vaccination campaign across Sweden's 21 regions.

The World Health Organisation (WHO) says the 2009-2010 pandemic killed 18,500 people, although a study last year said that total might be up to 15 times higher.

While estimates vary, Stiernstedt says Sweden's mass vaccination saved between 30 and 60 people from swine flu death. Yet since the pandemic ended, more than 200 cases of narcolepsy have been reported in Sweden.

With hindsight, this risk-benefit balance is unacceptable. "This is a medical tragedy," he said. "Hundreds of young people have had their lives almost destroyed."

PANDEMICS ARE EMERGENCIES

Yet the problem with risk-benefit analyses is that they often look radically different when the world is facing a pandemic with the potential to wipe out millions than they do when it has emerged relatively unscathed from one, like H1N1, which turned out to be much milder than first feared.

David Salisbury, the British government's director of immunization, says "therein lies the risk, and the difficulty, of working in public health" when a viral emergency hits.

"In the event of a severe pandemic, the risk of death is far higher than the risk of narcolepsy," he told Reuters. "If we spent longer developing and testing the vaccine on very large numbers of people and waited to see whether any of them developed narcolepsy, much of the population might be dead."

Pandemrix was authorized by European drug regulators using a so-called "mock-up procedure" that allows a vaccine to be authorized ahead of a possible pandemic using another flu strain. In Pandemrix's case, the substitute was H5N1 bird flu.

When the WHO declared a pandemic, GSK replaced the mock-up's strain with the pandemic-causing H1N1 strain to form Pandemrix.

GSK says the final H1N1 version was tested in trials involving around 3,600 patients, including children, adolescents, adults and the elderly, before it was rolled out.

The ECDC's Nicoll says early warning systems that give a more accurate analysis of a flu strain's threat are the best way to minimize risks of this kind of tragedy happening in future.

Salisbury agrees, and says progress towards a universal flu vaccine - one that wouldn't need last-minute changes made when a new strain emerged - would cuts risks further."Ideally, we would have a better vaccine that would work against all strains of influenza and we wouldn't need to worry about this ever again," he said. "But that's a long way off."

With scientists facing years of investigation and research, Emelie just wants to make the best of her life.

She reluctantly accepts that to do so, she needs a cocktail of drugs to try to control the narcolepsy symptoms. The stimulant Ritalin and the sleeping pill Sobril are prescribed for Emelie's daytime sleepiness and night terrors. Then there's Prozac to try to stabilize her and limit her cataplexies.

"That's one of the things that makes me feel most uncomfortable," she explains. "Before I got this condition I didn't take any pills, and now I have to take lots - maybe for the rest of my life. It's not good to take so many medicines, especially when you know they have side effects."

IMO a good objective summary of the situation. The urologists and radiation oncologists have too much financial stakes to be able to give rational explanations. Don't get me wrong. Their intentions were honorable in trying to combat this disease, but the fact of the matter is that PSA screening leads to a lot of testing, surgery radiation treatment and much anxiety among people who are found to have it. I discus with my male pts. the pros and cons and even give them a website to go to and read if they like and allow them to decide. Some decide against. Some appear incapable of understanding the controversies and usually opt for the test, and a few still want it. Bottom line I try to inform them the best I can and the choice is theirs. One caveat about the family history as one reason for men to do the test. If it is estimated 75% of men over 80 will have prostate cancer (though very few will ever know - unless we do a search and destroy mission) then most men, if they have ancestors who live long enough and get tested they now will have a family history. When I think of family history being relevant it is more important if they have a family member who either died of the disease or was younger when diagnosed. The risks are higher for Blacks for unknown reasons (NO it is not discriminatory or racist).

I don't know if anyone remembers from the DMG board years ago I pointed out my suspicion that the argument we should get people to stop smoking because they utilize more health care dollars while all the rest of us pay for their medical problems is flawed?

The concept that we will reduce costs in the long run by getting them to quit might be flawed. If these people die at 50 or 60 rather than living to 80 or more the US might save a bundle in social security, Medicare, and long term care costs.

Scott Gottlieb of FDA and (of Gilder's health stock letter fame and FDA guy) takes what I think is a tongue in cheek stance that we should just let the smokers (and obese) simply die. Why should society pay for their health ills keeping them alive?

CCP: "I pointed out my suspicion that the argument we should get people to stop smoking because they utilize more health care dollars while all the rest of us pay for their medical problems is flawed...The concept that we will reduce costs in the long run by getting them to quit might be flawed. If these people die at 50 or 60 rather than living to 80 or more the US might save a bundle in social security, Medicare, and long term care costs."

Doc, you are correct (as usual). Hubert Humphrey III made his mark with the states suing the tobacco companies for these 'costs'. Key point in the trial was the ruling made by the judge that the fact these people died more quickly includes a health care coszt savings, not counting what you point out Social security etc., when they get sick with lung cancer, emphysema etc was inadmissible.

Despicable to use their early death as a cost savings - except for the fact that the lawsuit was all about costs.

A libertarian view (aren't we a libertarian country?) is that it is none of government's business whether you are obese or smoke. Your mother, daughter, spouse, father, son, boss, neighbor or pastor can nag you about that, not the federal government. Now every choice you make affects a public expenditure. Every wet french fry you eat affects our currency relationship with China and the debt burden on children not yet born.

George Orwell could not foresee the number of cameras and the data mining systems that will double check your compliance.

Have you been told yet you to ask your patients about guns in the home yet? It's a health care cost now. The government will need to stop you from exercising your rights, based on false data and unconstitutional powers.

Yes. The paradox and twisted logic for political correctness. Saying that we should live like vegetarians, walk or bike ride to work, take yoga, avoid sugars, fats, alcohol (except maybe that one red wine at night) sounds wonderful. Some of us may even add a few years to our lives. Yet the reality is that there will be more people living longer on SS and the entitlements share of the pie will expand even more.

OTOH if we can keep older people healthy in a way they can move around and continue to perform cognitively as well as physically and keep them working or volunteering longer they would become a vital store of experience wisdom and contribute to society rather then the opposite. OF course we can't expect this now when it hurts to walk around, memories are not so good and people may have to wear diapers.

"George Orwell could not foresee the number of cameras and the data mining systems that will double check your compliance."

In recent med journals (I forget which one) there are articles from politburo members who are PhDs (nothing against PhDs but just the point that MBAs and PhDs are along with some MDs involved) in something like industrial engineering and work flow engineering. If one is not in health care in the US we probably all have a relative who is who can attest to health care evolving into something more resembling an assembly line. My mind is boggled every day with all the regulatory requirements and the absolute hair splitting of every single step in every single human interaction, function, task, as well as duplicate and triplicate controls. Perhaps for younger people more attune to this view of the world and daily life because of electronic gadgets it is not so rough. For me it is torture. Like "Secret Agent Man" they took away your name and gave you a number.

"Have you been told yet you to ask your patients about guns in the home yet? It's a health care cost now."

The only time I ask anyone that is if I am concerned they are so depressed that they may commit suicide. If they have a gun in the house I am more worried.

Other than that - no. And I will not. None of my damn business.

I don't ask people if they wear their seatbelts either. Enough is enough. I am not their nanny.

I'm all for having people's doctor helping them to live longer, a key reason we go there. Governing is different. Defend our shores, plow our streets etc. but not control all our behaviors and choices. Cigarettes under current science seem kind of obvious. Your odds of bad health consequences go way up. I'm fine with the warning label mandates and all kinds of educational efforts.

Problem is the government does not know where to stop. For this board, I point out an obvious future target and hope no one in government reads it: Martial Arts has health risks. And soccer, football, hockey, skiing, skydiving and eating breakfast lunch and dinner - all involve risk taking. A friend just died of snow shoveling (heart attack). Sex for older people they are already saying ask you doctor if that is okay for you, next could be prohibition. We joked that after cigarettes, what's next, french fries and soft drinks? It's not a joke anymore. Give them that power and it becomes their responsibility forever and they won't always get the science right or respect personal choices. (understatement)

- "Have you been told yet you to ask your patients about guns in the home? It's a health care cost now." The only time I ask anyone that is if I am concerned they are so depressed that they may commit suicide.

Pediatricians ask here. I let my daughter field the question, I had one at the time that she didn't know about. The doctor meant no big invasion, it was in the context of kids wearing bike helmets for safety. I just didn't like that it came as a direct question, as part of checklist, making a record on a very private matter he seemed compelled to ask. Maybe I am sensitive but I see a distinction between informing us about safety and creating a very personal record easily breached.

Sugar is indeed toxic. It may not be the only problem with the Standard American Diet, but it’s fast becoming clear that it’s the major one.

A study published in the Feb. 27 issue of the journal PLoS One links increased consumption of sugar with increased rates of diabetes by examining the data on sugar availability and the rate of diabetes in 175 countries over the past decade. And after accounting for many other factors, the researchers found that increased sugar in a population’s food supply was linked to higher diabetes rates independent of rates of obesity.

In other words, according to this study, obesity doesn’t cause diabetes: sugar does.

The study demonstrates this with the same level of confidence that linked cigarettes and lung cancer in the 1960s. As Rob Lustig, one of the study’s authors and a pediatric endocrinologist at the University of California, San Francisco, said to me, “You could not enact a real-world study that would be more conclusive than this one.”

The study controlled for poverty, urbanization, aging, obesity and physical activity. It controlled for other foods and total calories. In short, it controlled for everything controllable, and it satisfied the longstanding “Bradford Hill” criteria for what’s called medical inference of causation by linking dose (the more sugar that’s available, the more occurrences of diabetes); duration (if sugar is available longer, the prevalence of diabetes increases); directionality (not only does diabetes increase with more sugar, it decreases with less sugar); and precedence (diabetics don’t start consuming more sugar; people who consume more sugar are more likely to become diabetics).

The key point in the article is this: “Each 150 kilocalories/person/day increase in total calorie availability related to a 0.1 percent rise in diabetes prevalence (not significant), whereas a 150 kilocalories/person/day rise in sugar availability (one 12-ounce can of soft drink) was associated with a 1.1 percent rise in diabetes prevalence.” Thus: for every 12 ounces of sugar-sweetened beverage introduced per person per day into a country’s food system, the rate of diabetes goes up 1 percent. (The study found no significant difference in results between those countries that rely more heavily on high-fructose corn syrup and those that rely primarily on cane sugar.)

This is as good (or bad) as it gets, the closest thing to causation and a smoking gun that we will see. (To prove “scientific” causality you’d have to completely control the diets of thousands of people for decades. It’s as technically impossible as “proving” climate change or football-related head injuries or, for that matter, tobacco-caused cancers.) And just as tobacco companies fought, ignored, lied and obfuscated in the ’60s (and, indeed, through the ’90s), the pushers of sugar will do the same now.

But as Lustig says, “This study is proof enough that sugar is toxic. Now it’s time to do something about it.”

The next steps are obvious, logical, clear and up to the Food and Drug Administration. To fulfill its mission, the agency must respond to this information by re-evaluating the toxicity of sugar, arriving at a daily value — how much added sugar is safe? — and ideally removing fructose (the “sweet” molecule in sugar that causes the damage) from the “generally recognized as safe” list, because that’s what gives the industry license to contaminate our food supply.

On another front, two weeks ago a coalition of scientists and health advocates led by the Center for Science in the Public Interest petitioned the F.D.A. to both set safe limits for sugar consumption and acknowledge that added sugars, rather than lingering on the “safe” list, should be declared unsafe at the levels at which they’re typically consumed. (The F.D.A. has not yet responded to the petition.)

Allow me to summarize a couple of things that the PLoS One study clarifies. Perhaps most important, as a number of scientists have been insisting in recent years, all calories are not created equal. By definition, all calories give off the same amount of energy when burned, but your body treats sugar calories differently, and that difference is damaging.

And as Lustig lucidly wrote in “Fat Chance,” his compelling 2012 book that looked at the causes of our diet-induced health crisis, it’s become clear that obesity itself is not the cause of our dramatic upswing in chronic disease. Rather, it’s metabolic syndrome, which can strike those of “normal” weight as well as those who are obese. Metabolic syndrome is a result of insulin resistance, which appears to be a direct result of consumption of added sugars. This explains why there’s little argument from scientific quarters about the “obesity won’t kill you” studies; technically, they’re correct, because obesity is a marker for metabolic syndrome, not a cause.

The take-away: it isn’t simply overeating that can make you sick; it’s overeating sugar. We finally have the proof we need for a verdict: sugar is toxic.

First in medicine we don't view epidemiological findings as "proof". A real scientist would know this. It generally results to a hypothesis that is then later tested in double blind placebo controlled trials that try to avid the bias this author OBVIOUSLY has.

Second. Who the heck is PLoS? It is some sort of scientific "advocacy" group. Sounds like the climate change crowd. The same crowd that would like to regulate our daily lives.

I am not aware that this is any legitimate journal.

Third, I don't see any mention of genetic differences between countries. For example it is well know Latinos and Asians have much higher rates of diabetes even at lower weights. Could it be partly due high rice and maybe sugar intake - yes. But there is likely a genetic component as well.

I would say this study which I have not reviewed, if well done, as claimed, is interesting but nothing more.

Of course, I am sure this pseudoscientist who seems to know how to promote his numbers game as some sort of definitive Earth shattering discovery, would be very pleased to get a couple hundred grand from Axelrod and corp to "study" this further.

Doctors have long assumed that saturated fat and cholesterol in red meat are what raise the risk of heart disease. But a study in the journal Nature Medicine fingers another culprit: carnitine, a compound abundant in red meat that also is sold as a dietary supplement and found in some energy drinks.

Carnitine typically helps the body transport fatty acids into cells to be used as energy. But researchers at the Cleveland Clinic found that in both humans and mice, certain bacteria in the digestive tract convert carnitine to another metabolite, called TMAO, that promotes atherosclerosis, or a thickening of the arteries.

The researchers, led by Stanley Hazen, chief of cellular and molecular medicine at the Cleveland Clinic's Lerner Research Institute, tested the carnitine and TMAO levels of omnivores, vegans and vegetarians, and examined records of 2,595 patients undergoing cardiac evaluations. In patients with high TMAO levels, the more carnitine in their blood, the more likely they were to develop cardiovascular disease, heart attacks, stroke and death.

.Many studies have linked consumption of red and processed meat to cardiovascular disease and some cancers. The Harvard School of Public Health reported last year that among 83,000 nurses and 37,000 male health professionals followed since the 1980s, those who consumed the highest levels of red meat had the highest risk of death during the study, and that one additional serving a day of red meat raised the risk of death by 13%.

The new findings don't mean that red meat is more hazardous than previously thought. But they may help explain the underlying risk of eating red meat, which some researchers have long thought was higher than the saturated fat and cholesterol content alone could explain.

Dr. Hazen speculated that carnitine could be compounding the danger. "Cholesterol is still needed to clog the arteries, but TMAO changes how cholesterol is metabolized—like the dimmer on a light switch," he said. "It may explain why two people can have the same LDL level [a measure of one type of cholesterol], but one develops cardiovascular disease and the other doesn't."

One surprising finding, Dr. Hazen said, was how a long-term diet that includes meat affected the amount of TMAO-producing bacteria in the gut and thus magnified the risk. In the study, when longtime meat-eaters consumed an eight-ounce steak and a carnitine supplement, their bacteria and TMAO levels rose considerably. But when a vegan ate the same combination, he showed no increase in TMAO or bacterial change.

The study, sponsored by the National Institutes of Health, didn't assess how little red meat people could consume and still have elevated TMAO. Nor did it look at how long someone had to abstain from red meat to end the process. "We know it will be longer than one week, but shorter than one year," Dr. Hazen said.

He and his colleagues have been exploring how altering gut bacteria might influence the risk of heart disease. "In the future, maybe there will be a heart-healthy yogurt, or a drug to block the formation of TMAO," he said.

Trade groups for meat producers have questioned the link to cardiovascular disease, saying studies that ask people to recall what they ate over long periods are imprecise.

"Cardiovascular disease…is a complex condition that appears to have a variety of factors associated with it, from genetics to lifestyle," said Betsy Booren, chief scientist at the American Meat Institute Foundation.

As a dietary supplement, carnitine is designated as "generally regarded as safe" by the Food and Drug Administration, but few studies have looked at its long-term safety. A 2006 risk assessment found no adverse effects when subjects consumed 2,000 milligrams a day for six months. (An eight-ounce steak has roughly 200 mg of carnitine.)

Ads for supplements promote carnitine as helping boost energy levels, particularly in endurance sports, and assisting in recovery after intense exercise; some also claim that it helps shed pounds and improve brain function.

Duffy MacKay, vice president for scientific and regulatory affairs at the Council for Responsible Nutrition, a trade group for the supplement and energy-drink industries, called the study "a new, emerging hypothesis," but said the researchers were drawing large conclusions from small studies of mice, bacteria and human biomarkers. "The concept that one component of your diet, or one molecule, is responsible for your health woes is questionable," he said.

Dr. Hazen noted that some energy drinks have more carnitine in a single can than a porterhouse steak. "I worry about what happens in 10, 20 or 30 years of consumption," he said.

He said humans generally have plenty of carnitine in their diet, which also is found in small amounts in nuts, beans, vegetables and fruit, and don't need to take it in supplement form.

twenty five years ago hepatitis C wasn't even discovered. We used to call it non-AnonB hepatitis and we used to infer a person was infected from the abnormal liver tests. Since then we have discovered and characterized the virus produced a test to find if a person is infected and developed marginally good albeit getting better treatments. Soon it will be curable or long term controllable like HIV.

Agreed but I am not clear who is the winner(s). I am afraid I have NEVER made money in an health stock. I lost in corixa. I lost with inhaled insulin. Biomira. Pain therapeutics. I read vivus drug was great for weight loss and almost bought at ten only to chicken out and a few days later it doubled when drug approved.

Gilead sounds good but the train has left the station it seems. I watched Sanofi fall to low 30's after its Plavix patent expired thinking it was a good buy. I was right . It is now in 50s. Of course I didn't buy it.

I am only surprised the number is not higher. What the study doesn't address is the prevalence of bias against the obese in the general population. As for med students I have some points from my experience.

1- obesity treatments were not taught at all other the proverbial "diet and exercise" and simply admonishing a patient for not doing more in this regard. I can tell you this never works.Perhaps obesity treatment is taught better now ; I don't know.2- obesity treatment are often complicated and are a whole specialty unto itself though not a recognized one by the board of specialties - it should be. 3- obesity is very difficult to treat - very. Indeed the medical treatment is almost always with the realistic hope of some sustained weight loss not huge losses from obese to healthy. I heard one physician who devotes his entire practice say during a lecture, "in my 25 yrs of treating obesity if I have had 2 or 3 patients get from a BMI of 45 (morbid obese - overweight by 100 pounds or more) to a BMI of 25 (top number designated healthy) and keep it off that is a lot".4- Some experts appear to have thrown in the towel for medical treatment in those patients who are extremely overweight and from the very beginning steer them to bariatric surgery which has a DRAMATICALLY higher success rate.

FRIDAY, May 24 (HealthDay News) -- Two out of five medical students have an unconscious bias against obese people, a new study found.

The study authors, from Wake Forest Baptist Medical Center, noted the anti-fat stigma is a significant barrier to the treatment of obesity. They concluded that teaching medical students to recognize this bias is necessary to improve care for the millions of Americans who are overweight or obese.

"Bias can affect clinical care and the doctor-patient relationship, and even a patient's willingness or desire to go see their physician, so it is crucial that we try to deal with any bias during medical school," study lead author Dr. David Miller, associate professor of internal medicine at Wake Forest Baptist Medical Center, said in a center news release. "Previous research has shown that on average, physicians have a strong anti-fat bias similar to that of the general population. Doctors are more likely to assume that obese individuals won't follow treatment plans, and they [doctors] are less likely to respect obese patients than average weight patients."

The study, which took place over the course of three years, involved more than 300 third-year medical students. Although all of the students attended a medical school in the southeastern United States from 2008 through 2011, they were originally from many different parts of the United States as well as 12 other countries.

Using a computer program called the Weight Implicit Association Test, the researchers were able to measure the participants' unconscious preferences for fat or thin people. The medical students also completed a survey to determine if they were aware of any weight bias they had.

The study revealed that 39 percent of the medical students had a moderate to strong unconscious anti-fat bias. Seventeen percent had a moderate to strong anti-thin bias. The researchers added that less than 25 percent of the students were aware of their biases.

"Because anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity, teaching medical students to recognize and mitigate this bias is crucial to improving the care for the two-thirds of American adults who are now overweight or obese," Miller said. "Medical schools should address weight bias as part of a comprehensive obesity curriculum."

The study was published online May 23 in the Journal of Academic Medicine.****

If only....... he put his tongue in a condom......... or he stayed away from those Hollywood harlots....

Seriously, it is thought HPV is rarely the cause of head and neck cancer but for him to blame that when he smoked like a heroin addict for decades is absurd.

The statistical odds it was HPV rather than cigarettes is probably on the order hundred thousand to one. I suppose one could theorize that HPV may have made the toxic effects of the cigarettes even worse but even that is a stretch.

People who increased their consumption of red meat during a four-year period were more likely to develop Type 2 diabetes in a subsequent four-year period, according to an analysis involving about 150,000 people.

The analysis, led by researchers at the National University of Singapore, took data from three long-running Harvard University studies involving mostly nurses and doctors. The results were published online Monday in JAMA Internal Medicine, a journal of the American Medical Association. The studies were funded by grants from the National Institutes of Health.

While bumping up red-meat intake can raise diabetes risk, some experts suggest eating lean cuts of meat like certain steaks or lamb instead of fattier options like sausage.While prior studies have also found a link between red-meat consumption and the development of Type 2 diabetes, the new analysis is believed to be the first time researchers have tracked changes in red-meat consumption over time with the risk of developing Type 2 diabetes. Study participants filled out detailed questionnaires about the types of food and drinks they consumed at the beginning of the study and every four years. The analysis looked at some 20 years of data.

Broadly, the study showed that, compared with a group of people who had no change in red-meat intake, increasing red-meat consumption by more than a half-serving per day over a four-year period was associated with a 48% increase in the risk of developing Type 2 diabetes during the next four years.

However, reducing red-meat consumption by the same amount during the same time period didn't cut the risk of diabetes during the next four years. It did reduce the risk by 14% over a longer time period, though.

The changes were independent of other factors such as body weight and overall diet quality.

"Our results confirm the robustness of the association between red meat and [Type 2 diabetes prevention] and add further evidence that limiting red-meat consumption over time confers benefits for…prevention," the study authors wrote. An Pan, an assistant professor at the National University of Singapore's Saw Swee Hock School of Public Health, was the study's lead author.

Other doctors say red meat in and of itself isn't necessarily the trouble.

"It is not the type of protein (or meat) that is the problem; it is the type of fat," said William J. Evans, who is affiliated with both Duke University and GlaxoSmithKline PLC., GSK.LN -0.59% and who wrote a commentary about the study that was also published online in JAMA Internal Medicine. "It's mischaracterizing red meat as high fat," Dr. Evans said in an interview.

He said consumers could choose lean cuts of red meat such as sirloin tips or round steak over high-fat cuts like rib-eye.

Dr. Pan could not be reached for comment Monday.

Similar to general dietary guidelines from the U.S. government, the American Diabetes Association recommends people with diabetes eat lots of vegetables and fruit and choose whole-grain foods including dried beans, as well as eating fish two or three times a week. Lean meats include cuts of beef or pork that end in "loin," such as pork loin and sirloin.

Diabetes affects about 26 million Americans and is characterized by high blood-glucose levels caused by the body's inability to either make or properly use insulin. Type 2 diabetes, the most common form of the disease, is often associated with weight gain and older age. The disease raises the risk of heart attacks and strokes, kidney disease, blindness, amputations and nerve damage. The other type of diabetes, Type 1, is an autoimmune disease and often diagnosed in childhood.

The Centers for Disease Control and Prevention has projected that as many as 1 in 3 U.S. adults could have diabetes by 2050. The disease is currently the seventh leading cause of death in the U.S.

Doctors say that improving diet is important not only for managing diabetes, but for keeping the adult-onset Type 2 at bay for those with the highest risk. The CDC estimates that 35% of U.S. adults age 20 and older—nearly 80 million Americans, by the agency's estimate—are affected with prediabetes, a condition in which people have higher-than-normal blood-glucose levels. People with prediabetes also have a higher risk of developing problems like heart disease and stroke.

Researchers said one of the limitations of the study was that participants were mostly white, educated U.S. adults. Some groups have a higher risk than others for developing Type 2 diabetes, according to the diabetes association, including African-Americans and Hispanics.

The diabetes and red-meat analysis involved data from the Health Professionals Follow-Up Study collected between 1986 and 2006, as well as information from two groups of women in the Nurses' Health studies collected during a similar time period.

HPV tests are available to help screen women aged 30 years and older for cervical cancer. These HPV tests are not recommended to screen men, adolescents, or women under the age of 30 years. There is no general HPV test for men or women to check one's overall "HPV status." Also, there is not an approved HPV test to find HPV in the mouth or throat.****

Screening for cervical cancer in women. If the HPV leads to visible warts on genitals, mouth (mostly on HIV people), anal areas the infection is obvious.

There are investigational ways of looking for viral DNA in tissue samples but to my knowledge these are not widely available. Perhaps Michael Douglas paid for this out of pocket. In any case it would only have been of academic interest to him. Treatment for his cancer would not have changed (as far as I know).

If one had warts they could be removed until they don't return. Does this mean a person is cured and virus is eradicated, and protected from long term consequences? To my knowledge the answer is unknown. Could viral remnants still remain that can cause cancer years down the road? Again I am not aware of any definite answers to that.

A vaccine to protect teenage girls against dangerous strains of the human papillomavirus, or HPV, that are a leading cause of cervical cancer has proved to be enormously effective.

A study published Wednesday by the Centers for Disease Control and Prevention found that the prevalence of high-risk strains in teenage girls dropped by half after the vaccine was introduced in 2006, from 7.2 percent in 2006 to 3.6 percent in 2010.

Unfortunately, many parents still resist having their daughters immunized. A study published in March found that 44 percent of parents said in 2010 that they did not intend to vaccinate their daughters, up from 40 percent in 2008.

Some parents fear that vaccination might promote promiscuity (the new study found no sign of that); some see no need to vaccinate girls before they become sexually active, even though vaccination beforehand offers the best protection.

Health officials were surprised at the steep decline in infection rates because only about a third of American teenage girls have received the full course of three doses. In other advanced countries and even in a developing nation like Rwanda, vaccination rates have reached 80 percent or higher. Increasing the vaccination rate to 80 percent in this country could prevent an additional 53,000 cervical cancers and 17,000 deaths among girls now 13 years old and younger over the course of their lives.

Doctors need to recommend, and parents need to accept, a vaccine that can save thousands of lives.

Interesting new enzyme blocker which actually works to alter the metabolism for fat in the body and not simply an appetite suppressant. Company not public but if clinical studies continue to suggest safety and efficacy it will be.

Huge, huge risk. I looked up this class of drugs and they appear to have different and unknown actions in the body.

Our wonderful regulatory government can tax fatty foods, sugary foods, alcohol, pot, cigarettes guild walking and bicycle paths, go after soda makers and force companies to set up fitness plans for their employees all they want. But these kinds of drugs are the future of the treatment of obesity.

Researchers in Japan have used human stem cells to create tiny human livers like those that arise early in fetal life. When the scientists transplanted the rudimentary livers into mice, the little organs grew, made human liver proteins, and metabolized drugs as human livers do.

They and others caution that these are early days and this is still very much basic research. The liver buds, as they are called, did not turn into complete livers, and the method would have to be scaled up enormously to make enough replacement liver buds to treat a patient. Even then, the investigators say, they expect to replace only 30 percent of a patient’s liver. What they are making is more like a patch than a full liver.

But the promise, in a field that has seen a great deal of dashed hopes, is immense, medical experts said.

“This is a major breakthrough of monumental significance,” said Dr. Hillel Tobias, director of transplantation at the New York University School of Medicine. Dr. Tobias is chairman of the American Liver Foundation’s national medical advisory committee.

“Very impressive,” said Eric Lagasse of the University of Pittsburgh, who studies cell transplantation and liver disease. “It’s novel and very exciting.”

The study was published on Wednesday in the journal Nature.

Although human studies are years away, said Dr. Leonard Zon, director of the stem cell research program at Boston Children’s Hospital, this, to his knowledge, is the first time anyone has used human stem cells, created from human skin cells, to make a functioning solid organ, like a liver, as opposed to bone marrow, a jellylike organ.

Ever since they discovered how to get human stem cells — first from embryos and now, more often, from skin cells — researchers have dreamed of using the cells for replacement tissues and organs. The stem cells can turn into any type of human cell, and so it seemed logical to simply turn them into liver cells, for example, and add them to livers to fill in dead or damaged areas.

But those studies did not succeed. Liver cells did not take up residence in the liver; they did not develop blood supplies or signaling systems. They were not a cure for disease.

Other researchers tried making livers or other organs by growing cells on scaffolds. But that did not work well either. Cells would fall off the scaffolds and die, and the result was never a functioning solid organ.

Researchers have made specialized human cells in petri dishes, but not three-dimensional structures, like a liver.

The investigators, led by Dr. Takanori Takebe of the Yokohama City University Graduate School of Medicine, began with human skin cells, turning them into stem cells. By adding various stimulators and drivers of cell growth, they then turned the stem cells into human liver cells and began trying to make replacement livers.

They say they stumbled upon their solution. When they grew the human liver cells in petri dishes along with blood vessel cells from human umbilical cords and human connective tissue, that mix of cells, to their surprise, spontaneously assembled itself into three-dimensional liver buds, resembling the liver at about five or six weeks of gestation in humans.

Then the researchers transplanted the liver buds into mice, putting them in two places: on the brain and into the abdomen. The brain site allowed them to watch the buds grow. The investigators covered the hole in each animal’s skull with transparent plastic, giving them a direct view of the developing liver buds. The buds grew and developed blood supplies, attaching themselves to the blood vessels of the mice.

The abdominal site allowed them to put more buds in — 12 buds in each of two places in the abdomen, compared with one bud in the brain — which let the investigators ask if the liver buds were functioning like human livers.

They were. They made human liver proteins and also metabolized drugs that human livers — but not mouse livers — metabolize.

The approach makes sense, said Kenneth Zaret, a professor of cellular and developmental biology at the University of Pennsylvania. His research helped establish that blood and connective tissue cells promote dramatic liver growth early in development and help livers establish their own blood supply. On their own, without those other types of cells, liver cells do not develop or form organs.

“They were letting nature do its thing rather than trying to conceive of what the right signals might be,” Dr. Zaret said. But, he said, the mice were studied for only a couple of months. He would like to see what happens over a longer time.

“We don’t know if the cells will grow out of control or will poop out,” Dr. Zaret said.

Even if the liver buds never fulfill their clinical promise, they still could be enormously important for pharmaceutical research, Dr. Zon said. Drugs must be tested to see if they damage the liver, a major site of drug toxicity. Companies do this with liver cells taken from cadavers and grown in petri dishes. But the liver buds could be a big improvement and offer a large supply of rudimentary livers for testing.

“That would be huge,” Dr. Zon said. “It would open up lots of drugs in the pipeline and bring them to the clinic much more quickly.”

Dr. Takebe and his colleagues, though, are more focused on scaling up their process so they can think of trying to take it to the clinic, perhaps to treat babies and children whose livers have failed. Dr. Takebe estimates they would need hundreds of thousands, perhaps millions, of liver buds to replace 30 percent of the liver.

His gastroenterologist started him on steroids and anti-inflammatories — standard treatment for these ulcers. He felt better and within a few weeks was able to taper off the steroids, which can be dangerous if used over the long term. But a month later, the bleeding and diarrhea were back. He was in horrible pain that worsened when he ate or drank. He couldn’t sleep at night.

The doctor put him back on the steroids, but this time the symptoms weren’t held in check. For the next excruciating year, my friend went through episodes where he could do nothing but lie writhing in bed in pain. He lost frightening amounts of weight, became anemic from the blood loss and was forced to take medical leave from a job he loved.

According to his doctors, he was left with two options: powerful immunosuppressant drugs (the kind they give people after organ transplants) or a total colectomy (the removal of the colon). The drugs might not be effective, and they raised the risk of lymphoma or fatal infections, while with the surgical option, the tissue left behind could and often did eventually become ulcerated itself.

That’s when Gene started reading about a procedure called fecal microbiota transplant, or F.M.T.

Transplanting the stool from one person into the digestive tract of another seems, well, repulsive, but it also makes sense. The majority of the matter in stool — roughly 60 percent — is bacteria, dead and alive, but mostly alive. While bacteria can make us sick, they also constitute a large part of who we are; the hundreds of trillions of cells in an individual’s microbiome, as this collective is known, outnumber human cells 10 to 1. The bacteria serve many functions, including in metabolism, hormone regulation and the immune system.Katie Scott

The microbiome of the digestive system is particularly important. At least a thousand strains of bacteria coexist in a healthy human bowel, and beneficial bacteria are involved in vitamin production, digestion and keeping “bad” bacteria in check. Thus, changes to the gut microbiome can precipitate disease. For instance, taking a powerful antibiotic wipes out both good and bad gut flora, which can lead to opportunistic bacteria taking over and causing infection.

Many people who suffer from clostridium difficile, a dangerous strain of bacteria that is becoming epidemic in hospitals and nursing homes, got it this way. The idea behind fecal transfers is that restoring colonies of healthy bacteria can either dilute or crowd out these harmful strains. And it seems to work: in January, The New England Journal of Medicine reported that the first randomized clinical trial of F.M.T.’s for clostridium difficile had been halted because the treatment worked so well that it was unethical to withhold it from the control group.

The causes of ulcerative colitis are more mysterious than those of clostridium difficile (doctors in Gene’s case did not hazard a guess), but there is some speculation that the condition can also be traced to pathogenic bacteria. A small study of children with ulcerative colitis, published this spring in The Journal of Pediatric Gastroenterology and Nutrition, found that 78 percent had a reduction in symptoms within a week of being treated with fecal transfers.

The idea of using stool as medicine is not new. In the 16th century, during the Ming dynasty, fermented fecal concoctions, euphemistically named “yellow soup,” were used for digestive problems. In the 17th century, Christian Franz Paullini, a German physician, compiled a stool recipe book for treating dysentery and other digestive ailments. In the United States, fecal transplants have long been used on sick horses, and in 1958, Dr. Ben Eiseman pioneered the concept in humans, writing about the use of a fecal enema as a last-ditch effort for a patient with clostridium difficile.

Today, around 3,000 F.M.T.’s have been performed worldwide. No significant adverse reactions have been definitively attributed to the procedure (though there have been two F.M.T.’s that may have led to the transmission of the norovirus stomach bug, both of which cleared on their own within days).

CONVINCED that the potential benefits outweighed the risks, Gene decided, early this year, to try F.M.T. However, this turned out to be harder than he’d expected. There are only about 16 centers in the country that even offer the treatment. Gene finally secured an appointment with Dr. Lawrence Brandt, one of the most experienced F.M.T. practitioners, only to find out, just before his visit, that Dr. Brandt was suspending his F.M.T. practice for ulcerative colitis on the advice of the hospital’s lawyers, in order to comply with a new Food and Drug Administration decision. In April, the F.D.A. decided to classify human stool that is used therapeutically as a drug, and thus approved for use only within an F.D.A.-approved clinical study.

Gene tried tracking down other doctors, but found to his frustration that almost all of them had stopped doing F.M.T.’s as a result of the agency’s somewhat ambiguous restrictions. He found one remaining gastroenterologist, R. David Shepard, who had an excellent record of treating ulcerative colitis with fecal transfers and was still doing them. But Dr. Shepard was in Florida, and Gene was now too sick to travel.

Dr. Shepard, however, had a solution: he would help Gene with the mechanics of performing a do-it-yourself F.M.T., something he’d done successfully with a handful of other patients. Gene just had to find a donor.

The donor question was a tricky one. The donor has to be healthy (and will be screened, via stool and blood, for transmissible diseases like H.I.V., as well as for pathogens and parasites); has to avoid any foods the patient might be allergic to; and has to be nearby, as freshness is an issue: the bacteria mix may begin to change once the stool leaves the body.

THIS is where I enter the story. My friends know me as being somewhat evangelical about eating fresh fruits and vegetables. I also eat a lot of naturally fermented vegetables, which contain beneficial bacteria as well as the kind of fiber that nourishes good bacteria in the gut, and I follow a gluten-free diet (Gene had found that his colitis did better off gluten). Finally, I’m regular, which is also important. In the end, it was kind of inevitable that he ask me.

After the initial weirdness of the request wore off, I told him I’d be happy to do it.

The screening took one visit to the lab. The procedure is, of course, messy and odoriferous, but it’s also simplicity itself. Gene’s marching orders were to procure a dedicated blender and sieve, enema tubing and syringe, and lots and lots of newspaper. F.M.T. basically consists of blending stool with saline, straining it, and reintroducing it into the colon via enema.

I delivered my first donation, in Tupperware, and Gene took it into the privacy of his bathroom. I stayed, just in case I was needed, and after about half an hour, he came out and told me, with a look of wonder, that he was feeling better already. Already? We checked with Dr. Shepard, who told us that, indeed, one can feel the effects that quickly.

However, a few hours later, the cramps returned. The good bacteria appeared to be doing something, but hadn’t gained a foothold in Gene’s gut. We would need to keep doing the transfers — first twice a day, then just once a day.

By early May, Gene felt well enough to get on a plane to Dr. Shepard’s center in Florida, where he received a colonoscopic F.M.T. The doctor confirmed that instead of the multiple ulcers Gene once had, there’s only a single small one remaining.

He can’t declare his ulcerative colitis “cured,” because it could still return. However, for now, the diarrhea, bleeding and mental misery are in the past.

Of course, his experience is only one story, hardly a double-blind clinical trial. And there could be risks we don’t know about: could moving the genetic material of one person to another also transfer unwanted characteristics, like a propensity toward diabetes or cancer? More studies are needed. But at the same time, the F.D.A. needs to fast-track research into this field, though it is neither glamorous nor capable of promising a blockbuster drug payoff for some corporation.

Thankfully, just two weeks ago, the agency announced that it was easing some of the restrictions it imposed in April on the use of F.M.T. for clostridium difficile. But this does not apply to ulcerative colitis. Gene had been lucky to have received one of Dr. Shepard’s last F.M.T.’s.

Gene was also lucky (or desperate enough) to find a donor. Some patients have resorted to Craigslist. There is the possibility of creating synthetic stool, but given that there are thousands of unknown species of bacteria in human stool, there’s no way to know if it would be effective. In an ideal future, a universal screening panel will be put in place so that healthy people can donate their microbiota, the way you can with blood.

The upside for patients would be huge. In a maelstrom of skyrocketing health care costs, think of what we could save, in terms of quality of life and money, with this procedure. Clostridium difficile infections alone kill about 30,000 a year and cost billions of dollars. The prescription drugs for Gene’s ulcerative colitis, let alone the doctor visits and one hospitalization, ran into the tens of thousands of dollars. The F.M.T. was basically the cost of the blender and the enema materials.

Gene gained back much of the weight he’d lost and recently returned to work. He was feeling so good that, last month, he gave a party. He’d kept his illness very private and thus most people hadn’t seen him at his sickest — to them he probably just looked like himself. But I remembered how skeletal and hollow-eyed he looked and the incredible journey he took just to fight his way back to normal. Now, thanks to some doctors who are promoting the curative powers of what we once used to think of as “waste,” Gene has a new medicine, one that’s replenishable and has no co-pay.

As for me, in a normal world, I would prefer not to discuss my stool in a public forum. But seeing my friend restored to health has made me change my attitude. Every morning (like I said, I am very regular), I find myself with a new appreciation for this bacterial world that we share.Marie Myung-Ok Lee

Marie Myung-Ok Lee teaches writing at Columbia and is working on a novel about health care.

interesting research angle into the obesity and diabetes conditions. diabetes @ tends to reverse within a few days after bariatric surgery even before the major weight loss has occurred suggesting the anatomical changes in the proximal gut alter the chemistry via gastrointestinal hormones in a way the change metabolism. This same chemical alterations may lead to drugs that can induce the same changes without the surgery. NGM biopharmaceuticals is private but has entered into agreement with Medimmune:

NovoNordiscs victoza used for Type 2 diabetes treatment is known to induce several percent weight loss. At this time it is FDA approved only for diabetes. A dose of 3 mg (vs the 0.6 to 1.8 for diabetes) is being researched for FDA approval for use in obesity. It may cause and ?maintain up to 8% weigh loss. I am not sure if all its mechanisms are known. It delays stomach emptying this making feel full faster and less hungry and is also thought to work directly through the brain as well. I wonder if adding that to the VVUs drug would add additional benefits. Some combinations I have read do not add much if any benefit however.

*Of course for us male and female studs on this board we do not need such help. I am speaking of the millions of couch potatoes who sit at desks all day and commute for hours.*

HPV Vaccine Found to Help With Cancers of ThroatBy DONALD G. McNEIL Jr.Published: July 18, 2013

A vaccine that protects women against cervical cancer also appears to protect them against throat cancers caused by oral sex, and presumably would protect men as well, according to a study released Thursday.

Rates of this throat cancer have soared in the past 30 years, particularly among heterosexual middle-aged men. About 70 percent of oropharyngeal cancers are now caused by sexually transmitted viruses, up from 16 percent in the 1980s. The epidemic made headlines last month when the actor Michael Douglas told a British newspaper that his throat cancer had come from performing oral sex.

Oncologists have assumed that the human papillomavirus vaccine, which is used to prevent cervical cancer, would also prevent this other type of cancer, but this was the first study to provide evidence.

“This is a very nice paper,” said Dr. Marshall R. Posner, medical director for head and neck cancer at Mount Sinai Medical Center in New York, who was not involved in the study. “We expected this — that’s why we want everyone to vaccinate both boys and girls. But there’s been no proof.”

The study, supported by the National Cancer Institute, found that Cervarix, made by GlaxoSmithKline, provided 93 percent protection against infection with the two types of human papillomavirus that cause most of the cancers.

“We were surprised at how big the effect was,” said Dr. Rolando Herrero, head of prevention for the World Health Organization’s International Agency for Research on Cancer, and the study’s lead author. “It’s a very powerful vaccine.”

The study was done with 5,840 women in Costa Rica who were ages 18 to 25 and sexually active when it began. Four years after being vaccinated, each gave a mouthwash gargle sample that picked up cells from deep in the throat. Only one woman who had received the vaccine was infected with the viruses HPV 16 or HPV 18, the cancer-causing types; 15 women who had gotten a placebo vaccine were infected.

Dr. Herrero explained some of the study’s limitations: when it began, it was concerned only with cervical cancer, so no men were enrolled. The women were initially tested to make sure they had no cervical infections, but were not tested for throat or anal infections. They gave oral samples only once, so it was not possible to say how many had persistent infections; most people clear HPV infections on their own, so only a tiny fraction lead to cancer. Four years is not long enough to know how many cancers would develop — but finding out for sure would require waiting 20 years or more, and ethical guidelines require that all women in the trial get regular examinations and that any suspicious lesions be destroyed before they turn cancerous. Also, only Cervarix, and not Merck’s similar Gardasil vaccine, was tested.

However, Dr. Herrero said, men would “probably” get the same protection as the women did, because the vaccine produces identical antibody levels in both sexes.

Dr. Posner said the large discrepancy in infection rates between those who got the vaccine and those who got placebo suggested that the data was “very reliable” even though the infections were detected far too early to produce cancers.

“What we don’t know,” he said, “is how long-term the protection is, or if re-vaccination is necessary.”

While cancers caused by smoking or drinking usually occur in the mouth, those caused by oral sex usually occur at the base of the tongue or deep in the folds of tonsillar tissue, and are hard to detect. They are more common among heterosexual men than among women or gay men; experts believe that is because vaginal fluid contains more virus than the surface of the penis.

Dr. Eric J. Moore, a Mayo Clinic surgeon specializing in these cancers, said the study was “very encouraging.”

“But remember,” he added. “It only works if you’re vaccinated prior to contracting the infection. Once you’re 40 and have had multiple sexual partners, it’s not going to help.”

I've posted before how I think it wrong that there are countless sales pitches for so called natural products that "might" cure or treat every illness known to man with almost no legal or regulatory challenge.

I've posted before how I think it wrong that there are countless sales pitches for so called natural products that "might" cure or treat every illness known to man with almost no legal or regulatory challenge.

GM, I am not sure the FDA is "partisan" but I would agree there likely is corruption there from a money point of view.

There was an article about corrupt research and the FDA in Scientific American a couple of months back. If I can find it I will try to post.

I notice that in between my favorite talk radio shows, mostly on weekends are these endless so called experts (expert con artists if you ask me) hawking there latest natural treatments for all sorts of ubiquitous ills.

Almost all of it is nonsense. Even the "science" they base their claims are is junk and often corrupt.

Shetty is not a public health official motivated by charity. He’s a heart surgeon turned businessman who has started a chain of 21 medical centers around India. By trimming costs with such measures as buying cheaper scrubs and spurning air-conditioning, he has cut the price of artery-clearing coronary bypass surgery to 95,000 rupees ($1,583), half of what it was 20 years ago, and wants to get the price down to $800 within a decade. The same procedure costs $106,385 at Ohio’s Cleveland Clinic, according to data from the U.S. Centers for Medicare & Medicaid Services.

“It shows that costs can be substantially contained,” said Srinath Reddy, president of the Geneva-based World Heart Federation, of Shetty’s approach. “It’s possible to deliver very high quality cardiac care at a relatively low cost.”

Medical experts like Reddy are watching closely, eager to see if Shetty’s driven cost-cutting can point the way for hospitals to boost revenue on a wider scale by making life-saving heart operations more accessible to potentially millions of people in India and other developing countries.

“The current price of everything that you see in health care is predominantly opportunistic pricing and the outcome of inefficiency,” Shetty, 60, said in an interview in his office in Bangalore.

Out-of-Pocket Cutting costs is especially vital in India, where more than two-thirds of the population lives on less than $2 a day and 86 percent of health care is paid out of pocket by individuals. A recent study by the Public Health Foundation of India and the London School of Hygiene & Tropical Medicine found that in India non-communicable ailments such as heart disease are now more common among the poor than the rich.

One in four people there die of a heart attack and per-capita health spending is less than $60 a year. Yet the country performs only 100,000 to 120,000 heart surgeries each year, well short of the 2 million Shetty estimates are needed. The mortality rate from coronary artery disease among South Asians is two to three times higher than that of Caucasians, according to a study published in 2008 in the journal Vascular Health and Risk Management.

Dietary Patterns “There has been fast urbanization in India that’s brought with it a change in dietary patterns and lifestyle,” said Usha Shrivastava, head of public health at the National Diabetes, Obesity and Cholesterol Foundation. “It’s leading to this huge jump in cardiovascular disease.”

The average age for a first heart attack in India, Pakistan and other South Asian nations was 53 years, compared with 58.8 years in countries outside the region, according to a study published in 2007 in the Journal of the American Medical Association.

The biggest impediment for heart surgery in India is accessibility. Shetty aims to bridge that by building hospitals outside India’s main cities. He said he plans to add 30,000 beds over the next decade to the 6,000 the hospital chain has currently, and has identified 100 towns with populations of 500,000 to 1 million that have no heart hospital.

A 300-bed, pre-fabricated, single-story hospital in the city of Mysore cost $6 million and took six months for construction company Larsen & Toubro Ltd. to build, Shetty said. Only the hospital’s operating theaters and intensive-care units are air-conditioned, to reduce energy costs.

Changing Procedures One of the ways in which Shetty is able to keep his prices low is by cutting out unnecessary pre-op testing, he said.

Urine samples that were once routine before surgery were eliminated when it was found that only a handful of cases tested positive for harmful bacteria. The chain uses web-based computer software to run logistics, rather than licensing or building expensive new systems for each hospital.

That might cover the cost of linens here:

****When Shetty couldn’t convince a European manufacturer to bring down the price of its disposable surgical gowns and drapes to a level affordable for his hospitals, he convinced a group of young entrepreneurs in Bangalore to make them so he could buy them 60 percent cheaper.

In the future, Shetty sees costs coming down further as more Asian electronics companies enter the market for CT scanners, MRIs and catheterization labs -- bringing down prices. As India trains more diploma holders in specialties such as anesthesiology, gynecology, ophthalmology and radiology, Narayana will be able to hire from a larger, less expensive talent pool.

One positive unforeseen outcome may be that many of the cost-saving approaches could be duplicated in developed economies, especially in the U.S. under health reform.

“Global health-care costs are rising rapidly and as countries move toward universal health coverage, they will have to face the challenge of providing health care at a fairly affordable cost,” said the World Heart Federation’s Reddy, a New Delhi-based cardiologist who is also president of the Public Health Foundation of India. ****

The article does not specify details but I can see the report in the journal. Other organizations have already recommended this. The pulmonary doctors and those who own CT scans are dancing in the streets now. I don't necessarily agree with ding these but this endorsement will definitely give the green light to screening tests: